Stephen Brodovsky MD, FRCSCStephen Brodovsky MD, FRCSCUniversity of ManitobaUniversity of ManitobaWinnipeg, MBWinnipeg, MB
Travel Health:Travel Health: iTips iTips for Travelfor TravelVision 2020: ChallengesVision 2020: Challenges in Globalin Global
Eye CareEye Care
Travel Health:Travel Health: iTips iTips for Travelfor Travel
Dual Objectives:• Describe common ocular problems experienced by
traveling Canadians• Describe eye diseases and aid programs in the
developing world
Travel Health:Travel Health: iTips iTips for Travelfor Travel
Common travel problemsCommon travel problems
• “Pink eye”• Dry eye• Contact lens related problems• Viral, bacterial or allergic conjunctivitis• Corneal infections
• Flashes and floaters• Trauma:
•Corneal abrasions•Blunt trauma
Cartoon
“Pink Eye”Usually refers to a viral or bacterial conjunctivitis90% are viral and will resolve without antibioticsUsually associated with an URTI
Conjunctival injection: one or both eyesMucopurulent dischargeLids crusted shut in am, swelling +/-, cellulitisMay have a pre-auricular lymph nodeOther family members have been affected
Treated with topical antibiotics: eg. Polysporin, Ciprofloxacin or Erythromycin drops
“Pink Eye”Can also be allergic: itchy and bilateralSeasonalTreated with a combination drop (topical antihistamine & mast cell stabilizer) eg. Patanol, Zaditor
“Pink Eye” treatment for travel
Topical polysporin is available over the counter and is useful for the common bacterial pathogens (Strep, H. Flu, Staph)1 drop (not 2 to 3) qid for 7 days is all that is requiredPrescription drops such as ofloxacin or ciprofloxacinRemember it is usually viral!
Pink Eye = Dry Eye?
Dry Eye: anatomy
Symptoms include:
•Redness
•Irritation
•Foreign body sensation
•Tearing
•Blurred vision
Dry Eye: Symptoms
• common ocular complaint resulting from •decreased tear production •excessive evaporation
•Tear deficient dry eye:•Sjogren’s associated with connective tissue disease (Rheumatoid arthritis)•Non-Sjogren’s (primary or 2ndary)
•Evaporative dry eye•Blepharitis with obstructed Meibomian glands (assoc with Rosacea)•Blink and lid positional disorders
Dry Eye : etiology and classification
Cartoon
Dry Eye: Travel tips
Exacerbated by air travel (dehumidified air)Worse in dry environments: deserts, air conditioningMore common in women, especially with onset of menopause.
Dry Eye: RecommendationsRemove contact lens prior to flightUse artificial tears (bottled or preservative free)Deal with dry eye symptoms prior to travel
Contact lens problems
Dry eyeRed eye: overwear, dirty lenses, reaction to lensesCorneal ulcers
Contact lens problems
Worn by 12% of the populationSoft disposable contacts are most popularDaily disposable, Biweekly, MonthlyHard contact lenses in special circumstancesAnnual incidence 0.2% (1 in 500)Sleeping in contacts increases the risk of infection 5-10 fold
Contact lenses: Prevention
Discourage bad care habitsOver-wearing disposable lensesSleeping in contact lensesSwimming in contacts in tropical areasOld casesOld solutions
Corneal Ulcers: Symptoms
Red eyeSevere pain (mistaken for a scratch/abrasion)TearingDischargeWhite spot on the cornea whose visibility with the naked eye depends on the severity of the ulcerLight sensitivity (photophobia)
Contact lenses: corneal ulcers
Contact lenses: Travel suggestions
Daily disposable contact lensesBackup glassesTopical broad spectrum antibiotic??
Polysporin vs flouroquinolone (topicalciprofloxacin)
Flashes & floaters Figure
Flashes and FloatersCommon symptom in
Myopes (near sighted individuals)Persons aged 50-70 years of age with posterior vitreous detachmentsFollowing cataract surgery
Posterior Vitreous Detachment (PVD)
70% of individuals will have a PVD by age 70
Overall 10 - 15% will have a retinal tear which may lead to a retinal detachment
Retinal detachment
Retinal detachment
Starts with floaters and flashing lightsPt notices a shadow in their peripheral vision which gradually approaches the center of their vision (over hours/days/weeks)Should be repaired as an urgent/emergent problem especially once central vision is affected
Trauma
Corneal abrasionsBlunt or penetrating injuries
Corneal Abrasions
Usually due to trauma from a finger, tree branch or projectile
Corneal abrasions: Treatment
Patch with antibioticsTopical antibiotics and NSAIDBandage contact lens
Trauma-Blunt injuries: punch, ball, etc-Penetrating: ocular emergency
hyphemaCorneal laceration
Challenges in Global Eye Care
Vision 2020: WHO Challenges in Global Eye Care
Worldwide: 45 million people are blind80% is treatable or preventable50% of childhood blindness is avoidable90% of blind people live in the developing world
Number of blind expected to reach 76 million by the year 2020
Vision 2020: Global Facts 2008
Vision 2020: Main Causes of Blindness
Cataract (surgically treatable) 39%Refractive error (correctable with glasses) 18%Glaucoma 10%Macular Degeneration (retinal) 7%Corneal Scars 4%Trachoma 3%Other (diabetes, congenital) 19%
Vision 20/20: SolutionsTraining eye care professionals (ophthalmologists, ophthalmic assistants, technicians, opticians) andImproving accesibility and quality of careIncreasing public awareness that blindness can be treatedAdvocating for improved eye care services for woman, children and rural populations
Orbis: FLYING EYE HOSPITAL
Vision 20/20: Solutions
Many aid organizations:OrbisSeva Canada and Seva FoundationUnite for SightFred Hollows Foundation (Australia)Harold Ridley Foundation (UK)
CYBERSIGHT® and INTERNATIONAL FELLOWSHIPS
COUNTRY HOSPITAL-BASED PROGRAMS
ETHIOPIA 13 projects
Ethiopia has one of the highest levels of avoidable blindness in the world.
Yet there is only one ophthalmologist for every million people – almost all practice in Addis Ababa while 85% of the population live in the rural areas.
Ethiopia
TrachomaEthiopia
Trachoma is one of the oldest and most painful of all eye diseases. In some areas, 50% of children under 6 have active trachoma – an infection which causes the eyelids to turn inwards and rub against the eye eventually causing corneal ulceration and blindness.
Orbis: Lid effects of trachoma
Trachoma: Misdirected lashes causes scarring
Ethiopia:
ORBIS has introduced a surgical training program for local nurses so they can perform basic surgical procedures in order to make trichiasis treatment accessible to rural communities.
Trachoma
Orbis: Trachoma surgery
Mass treatment with Azithromycin has led to massive reductions in infection rates with decreased ocular sequelae
Orbis: Corneal disease5% of treatable blindness is due to corneal diseaseScars from infections, trauma, Vitamin A deficiencyand trachoma
Ethiopia: Orbis Corneal Transplants
Ethiopia: Orbis Corneal Transplants
Seva: Nepal Cataract surgery
Seva: Nepal Cataract surgery
Cataract surgery video
Seva: Nepal Cataract surgery
Seva: Nepal stats Cataract surgery
Seva: Nepal Cataract surgery
Tropical Eye Infections• Leprosy (Mycobacterium leprae): Africa, Asia, Central and South America. Corneal scarring and lid disease
•Toxoplasmosis (Protozoan parasite) Uveitis (intra-ocular inflammation)
•Trachoma: East Africa. Chronic conjunctivitis, lid disease with secondary corneal scarring
•Hydatid disease (cysticercosis): worldwide (associated with domestic animals) Orbital lesions and intra-ocular cysts
•Dengue fever (arboviral infection) (south east Asia, Brazil & Caribbean) blurred vision due to retinal hemorrhages & inflammation
•Onchocerciasis: Sub-Saharan Africa•River Blindness. Nematode transmitted by black fly bites•Corneal scarring and uveitis (intraocular inflammation)•Treatable with Ivermectin
•Schistosomiasis: Sub-Saharan Africa, China, South Asia• Fresh water exposure with intraocular inflammation (uveitis/retinitis)
•Loa loa•Sub-Saharan Africa•Sub-conjunctival worm•Not sight threatening
Tropical Eye Infections
Reference:
Conclusion•Summary of common ocular travel concerns/conditions
•Causes of global blindness
•Spectrum of tropical eye diseases